Erosion of professional behaviors in physical therapist students

Journal of Physical Therapy Education, Fall 2001 by Carey, James R, Ness, Kirsten K

Developing professionalism in students is an important goal of all physical therapist education programs. We assert that, in some students, consumerism undermines the development of professionalism. A commonality among all health care professions in defining professionalism is human respect. We cite examples of how student respect for faculty is ailing. We expose this concern because we believe that awareness of the problem is an important step in correcting it, and we claim that students, faculty, the profession, and patients all stand to gain.

Key Words: Consumerism, Physical therapist education, Professional behaviors, Student.

INTRODUCTION

Graduate professional education in health care includes not only the learning of specialized knowledge and skills but also the acculturation of the values, beliefs, and attitudes of that profession. As with many health care professions, professionalization in physical therapy commences with student matriculation into the professional education program. Traditionally, the professional curriculum includes course work that addresses this topic; however, this may not be sufficient to satisfactorily prepare today's students for clinical practice. In some students, we observe that professionalism is being subverted by a growing trend toward consumerism, and we believe that this problem jeopardizes not only their own professional competence but the effectiveness of faculty as well. The purpose of this article is to describe what we believe are conflicting student behaviors between professionalism and consumerism, with the hope that increased awareness by all will correct the problem.

PROFESSIONALISM: CENTERED ON HUMAN RESPECT

For this article, we define professionalism as the display of attitudes and behaviors that portray the traits endeared by a specialized discipline of study and practice. The expected attitudes and behaviors are similar in many health care professions. For pharmacy, Hill1 described these traits as specialized knowledge and skills, self-improvement, service orientation, pride in profession, covenantal relationship with the client, creativity, trustworthiness, accountability, ethical behavior, and leadership. For medicine, Cohen2 emphasized altruism, respect, compassion, honesty, and integrity. For occupational therapy, Bossers et al3 created a schemata of professionalism that included such behaviors as conflict resolution, feedback, respect, diplomacy, role negotiation, value contribution, and cooperation.

Malone4 described professionalism in nursing as "a physical, mental and emotional stretch that moves the nurse from the depths of human emotional reactions of attraction and rejection to the pinnacle of ability to deliver a higher level of quality care for each and every patient." She likened professionalism to a muscle that gets stronger with use and atrophies with disuse. She encouraged all to "stretch" their "professionalism muscle" consciously, with both their patients and with each other. She emphasized that the core meaning of health care is utter respect for all human beings, no matter their status in life.

In physical therapy, May et al5 have identified a repertoire of desirable student abilities, or "generic abilities," that form the professional behaviors expected of professional (entry-level) practitioners. They defined professionalism as the ability to exhibit appropriate professional conduct and to represent the profession well. At the most basic level, a student who exhibits professional behavior demonstrates honesty, courage, and continuous regard for all.

Thus, the attitudes and behavioral characteristics that constitute professionalism among the health care professions are multiple, but at the very core, whether explicit or implicit, is a common theme-human respect The tendency to respect and regard others in action and in words may be inborn in students who choose a health care profession; however, the skill to display this ability must be developed and practiced. The "professionalism muscle" must be stretched and strengthened so that it is refined for effective human interaction in both patient-professional and professional-professional relationships.

However, as central as human respect is to effective practice as a health care professional, we assert that some students show a deficiency in developing and practicing this behavior. Specifically, based on our own qualitative observations of students and through testimonials from other academic faculty, clinical faculty, and fellow students, student respect for faculty is ailing. Although such disrespect is exhibited by only a fraction of the student body, we contend that the impact of even a few is strong enough to impose a liability on the school and thereby the other students. Ultimately, without correction, the disrespect may be displayed in the arena of patient care, discrediting not only the professional but the profession as a whole.

IS CONSUMERISM REPLACING PROFESSIONALISM?

Why do some students fail to develop respectful behavior in their interactions with faculty, clinical instructors, and peers? We contend that the problem lies in the student's and in society's belief that education is a commodity to be consumed rather than an active process in which they should participate. Increasingly, students see themselves as consumers. One way to define consumerism is the consumption of goods and services that one believes to be of value.6 Educational consumerism then, is the consumption of information that is of value and that is delivered to student customers in a way they deem acceptable.